Ashton H
Department of Pharmacological Sciences, University of Newcastle upon Tyne, UK.
Addiction. 1994 Nov;89(11):1535-41. doi: 10.1111/j.1360-0443.1994.tb03755.x.
Withdrawal of benzodiazepines is currently advised for long-term benzodiazepine users because of doubts about continued efficacy, risks of adverse effects, including dependence and neuropsychological impairment and socio-economic costs. About half a million people in the UK may need advice on withdrawal. Successful withdrawal strategies should combine gradual dosage reduction and psychological support. The benzodiazepine dosage should be tapered at an individually titrated rate which should usually be under the patient's control. The whole process may take weeks or months. Withdrawal from diazepam is convenient because of available dosage strengths, but can be carried out directly from other benzodiazepine. Adjuvant medication may occasionally be required (antidepressants, propranolol) but no drugs have been proved to be of general utility in alleviating withdrawal-related symptoms. Psychological support should be available both during dosage reduction and for some months after cessation of drug use. Such support should include the provision of information about benzodiazepines, general encouragement, and measures to reduce anxiety and promote the learning of non-pharmacological ways of coping with stress. For many patients the degree of support required is minimal; a minority may need counselling or formal psychological therapy. Unwilling patients should not be forced to withdraw. With these methods, success rates of withdrawal are high and are unaffected by duration of usage, dosage or type of benzodiazepine, rate of withdrawal, symptom severity, psychiatric history or personality disorder. Longer-term outcome is less clear; a considerable proportion of patients may temporarily take benzodiazepines again and some need other psychotropic medication. However, the outcome may be improved by careful pharmacological and psychological handling of withdrawal and post-withdrawal phases.
鉴于对长期使用苯二氮䓬类药物的持续疗效、不良反应风险（包括依赖性和神经心理损害）以及社会经济成本存在疑虑，目前建议长期使用苯二氮䓬类药物的患者停药。在英国，约有50万人可能需要停药方面的建议。成功的停药策略应将逐渐减少剂量与心理支持相结合。苯二氮䓬类药物的剂量应以个体滴定的速率逐渐减少，该速率通常应在患者的控制之下。整个过程可能需要数周或数月。由于有多种可用的剂量规格，停用地西泮较为方便，但也可直接从其他苯二氮䓬类药物开始停药。偶尔可能需要辅助药物（抗抑郁药、普萘洛尔），但尚无药物被证明对缓解停药相关症状具有普遍效用。在减少剂量期间以及停药后的几个月内都应提供心理支持。这种支持应包括提供有关苯二氮䓬类药物的信息、一般性鼓励，以及减少焦虑和促进学习应对压力的非药物方法的措施。对于许多患者来说，所需的支持程度很小；少数患者可能需要咨询或正规的心理治疗。不应强迫不愿意停药的患者停药。采用这些方法，停药成功率很高，且不受使用时间、剂量、苯二氮䓬类药物类型、停药速率、症状严重程度、精神病史或人格障碍的影响。长期结果尚不清楚；相当一部分患者可能会再次临时服用苯二氮䓬类药物，一些患者需要其他精神药物。然而，通过对停药及停药后阶段进行仔细的药物和心理处理，结果可能会得到改善。
